1. Field of the Invention
This invention relates to pelvic endoscopic surgical procedures and, more particularly, to an apparatus that can be used to simultaneously support the uterus and distend the vagina through the placement of resilient moisture absorbent material around the cervix. This facilitates identification of the vaginal apex and prevents vaginal collapse around the cervix, to thereby minimize escape of gas used to distend the abdominal cavity, as during the performance of a laparoscopic hysterectomy.
2. Background Art
It is estimated that in the last year approximately 600,000 hysterectomies were performed. Hysterectomies are conventionally performed either through the abdomen or the vagina.
The abdominal hysterectomy is performed by making an incision in the abdomen which is large enough to access, sever and remove the uterus with or without the fallopian tubes and ovaries. The procedure is completed by stitching closed the vaginal opening which is penetrated by the cuff of the cervix. The abdominal hysterectomy is desirable in that it can be performed on virtually all patients. The principal drawbacks associated with this type of procedure are that the patient experiences pain from the incision and healing may require relatively lengthy hospitalization.
The vaginal hysterectomy is performed through the vaginal opening by progressively cutting out and removing the uterus, fallopian tubes and ovaries. Performance of the hysterectomy by the vaginal technique is preferred over the abdominal technique principally because the patient remains unscarred and may require only a short hospital stay.
The vaginal technique has several limitations however. First of all, performance of the vaginal hysterectomy requires a relaxed vaginal opening, to permit access to the cervix and beyond. Therefore, not all women are candidates for laparoscopic hysterectomies, particularly those who have not already borne children.
Recently, a laparoscopic technique has been described through which the uterus is removed through the vagina. This technique utilizes a telescope, video camera and monitor and various other special instruments introduced into the abdomen through small incisions.
The principal drawback with vaginal hysterectomies is the inherent dangers associated with this type of operation due to a) loss of depth perception from a video screen as well as the loss of palpatory information otherwise available with an open abdomen and b) the limited points of access through which instruments can be directed and utilized. The region of the uterus which is severed during a hysterectomy is in close proximity to the rectum, bladder and other vital organs which, if inadvertently cut or severed, could cause severe internal injury or even death. The operation itself is a very delicate one requiring the disconnection of the ovaries, the ligaments supporting the uterus, etc. in a very precise fashion. Accordingly, during the laparoscopic procedure, it is necessary that all internal organs be positively identifiable at all times during the surgery.
To provide the necessary visibility during the performance of the laparoscopic hysterectomy, it is important to distend the abdominal cavity by the introduction of a gas to enlarge the working area. However, once a vaginal incision is made, the system is no longer closed and the gas escapes. This results in a confined working area. Blood accumulation therein virtually destroys what little visibility remains. To continue the surgery under these circumstances, special tools are required to open the vaginal cuff. To effectively do this, it is important that the uterus be supported in a proper orientation, which may require even additional instruments.
To overcome these problems, it is known to provide rods with sponges on the ends thereof to block the escape of gas after an incision is made into the vaginal apex during laparoscopic hysterectomy. Commonly, one or a plurality or the rods are directed through the vagina into the vicinity of the cervical cuff. The principal difficulty with this conventional technique is that the surgeon is required to blindly direct the sponge into position. A misdirected rod could itself cause a rupture or difficulty in identifying the vaginal apex with possible subsequent entry into the bladder or rectum.
Additionally, it is difficult and may be virtually impossible for the surgeon to control the positioning of all of the separate instruments that are directed through the vaginal opening to distend the vaginal apex and elevate the uterus at the same time during the hysterectomy. Not only is there the potential for interference between the many instruments, but there is also increased likelihood that the surgeon may confuse the identity of the instruments with again potentially dire consequences.